Exposure and early effect biomarkers for risk assessment of occupational exposure to formaldehyde. A systematic review

The aim of the present review was to identify all the biomarkers used for assessing the internal dose and the related early effects determined by the occupational exposure to formaldehyde. For this purpose, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in PROSPERO (ID: CRD42023416960). An electronic search of Pubmed, Scopus, and Web of Science was performed to collect all the papers concerning the focus of the review and published from the inception of each database until 18 September 2023. Articles were considered eligible if they reported data from observational studies, semi-experimental, and experimental studies on adult workers who were occupationally exposed to formaldehyde, regardless of gender or age. The quality assessment was performed using the adapted Newcastle–Ottawa Quality Assessment Scale. From 1524 articles, 52 were included. Few studies assessed the exposure to formaldehyde in occupational settings through biomarkers, especially by measuring formic acid in urine. The most common approach for evaluating the effects derived from occupational exposure to formaldehyde was the use of the cytogenetic biomarker micronucleus assay in peripheral blood lymphocytes and/or epithelial buccal cells